Usmle Step 2 Cs

Front 1

26 y/o male presents after falling and losing consciousness at work. He had rhythmic movements of the limbs, bit his tongue, and lost control of his bladder. He was subsequently confused (as witnessed by bystanders)

Back 1

Seizure, grand mal (now called complex tonic-clonic seizure)

Front 2

55 y/o male c/o falling after feeling dizzy and unsteady. He experienced transient LOC. He has hypertension and is on numerous antihypertensive drugs

Back 2

Drug-induced orthostatic hypotension (causing syncope)

Front 3

65 y/o male presents after falling and losing consciousness for a few seconds. He had no warning prior to passing out but recently had palpitations. His past history included CABG

Back 3

Cardiac arrhythmia (causing syncope)

Front 4

68 y/o male presents following a 20 minute episode of slurred speech, right facial drooping and numbness, and right hand weakness. His symptoms had totally resolved by the time he got to the ER He has a history of hypertension, diabetes mellitus, and heavy smoking

Back 4

Transient ischemic attack

Front 5

68 y/o M presents with slurred speech, right facial drooping and numbness, and right hand weakness. Babinski's sign is present on the right. He has a history of hypertension, diabetes mellitus, and heavy smoking

Back 5

Stroke

Front 6

33 y/o F presents with ascending loss of strength in her lower legs over the past two weeks. She had a recent URI

Back 6

Guillain-Barre syndrome

Front 7

30 y/o F presents with weakness, loss of sensation, and tingling in her left leg that started this morning. She is also experiencing right eye pain, decreased vision, and double vision. She reports feeling "electric shocks" down her spine upon flexing her head

Back 7

Multiple sclerosis

Front 8

55 y/o M presents with tingling and numbness in the hand and feet (glove and stocking distribution) over the past two months. He has a history of diabetes mellitus, hypertension, and alcoholism. There is decreased soft touch, vibratory, and position sense in the feet

Back 8

Diabetic peripheral neuropathy

Front 9

40 y/o F presents with occasional double vision and droopy eyelids at night with normalization by morning

Back 9

Myasthenia gravis

Front 10

25 y/o M presents with hemiparesis (after a tonic-clonic seizure) that resolves over a few hours

Back 10

Todd's paralysis

Front 11

40 y/o F c/o feeling tired, hopeless, and worthless and of having suicidal thoughts. She recently discovered that her husband is homosexual

Back 11

Depression

Front 12

44 y/o M presents with fatigue, insomnia, and nightmares about a murder that he witnessed in a mall one year ago. Since then, he has avoided that mall and has not gone out at night

Back 12

PTSD

Front 13

55 y/o M presents with fatigue, weight loss, and constipation. He has a family history of colon cancer

Back 13

Colon cancer

Front 14

40 y/o F presents with fatigue, weight gain, sleepiness, cold intolerance, constipation, and dry skin

Back 14

Hypothyroidism

Front 15

50 y/o obese F presents with fatigue and daytime sleepiness. She snores heavily and naps 3-4 times per day but never feels refreshed. She also has hypertension

Back 15

Obstructive sleep apnea

Front 16

20 y/o M presents with fatigue, thirst, increased appetite, and polyuria

Back 16

Diabetes mellitus

Front 17

35 y/o M policeman c/o feeling tired and sleepy during the day. He changed to the night shift last week

Back 17

Sleep deprivation

Front 18

30 y/o M presents with night sweats and swollen glands of one month's duration

Back 18

Tuberculosis

Front 19

25 y/o F presents with a three-week history of falling asleep. She sleeps seven hours per night without nightmares or snoring. She recently began college and is having trouble with her boyfriend. She drinks 3-4 cups of coffee a day

Back 19

Stress-induced insomnia

Front 20

55 y/o obese M presents with several months of poor sleep and daytime fatigue. His wife reports that he snores loudly

Back 20

Sleep apnea

Front 21

33 y/o F c/o three weeks of fatigue and trouble sleeping. She states that she falls asleep easily but wakes up at 3 AM and cannot return to sleep. She also reports an unintentional weight loss of 3.5 kg along with an inability to enjoy the things she once liked to do

Back 21

Insomnia related to major depressive disorder

Front 22

26 y/o F presents with sore throat, fever, severe fatigue, and loss of appetite for the past week. She also reports epigastric and LUQ discomfort. She has cervical lymphadenopathy and a rash. Her boyfriend recently experienced similar symptoms

Back 22

Infectious mononucleosis

Front 23

26 y/o M presents with sore throat, fever, rash, and weight loss. He has a history of IV drug abuse and sharing needles

Back 23

HIV, acute retroviral syndrome

Front 24

26 y/o F presents with fever and sore throat

Back 24

Pharyngitis (bacterial or viral)

Front 25

30 y/o M presents with shortness of breath, cough, and wheezing that worsen in cold air. He has had several such episodes over the past four months

Back 25

Asthma

Front 26

56 y/o F presents with shortness of breath, as well as productive cough that has occured over the past two years for at least three months each year. She is a heavy smoker

Back 26

COPD--chronic bronchitis

Front 27

58 y/o M presents with pleuritic chest pain, fever, chills, and cough with purulent yellow sputum. He is a heavy smoker with COPD

Back 27

Pneumonia

Front 28

25 y/o F presents with two weeks of a nonproductive cough. Three weeks ago she had a sore throat and a runny nose

Back 28

Atypical pneumonia

Front 29

65 y/o M presents with worsening cough over the past six months together with hemoptysis, dyspnea, weakness, and weight loss. He is a heavy smoker

Back 29

Lung cancer

Front 30

55 y/o M presents with increased dyspnea and sputum production over the past three days. He has COPD and stopped using his inhalers last week. He also stopped smoking two days ago

Back 30

COPD exacerbation (bronchitis)

Front 31

34 y/o F nurse presents with worsening cough of six weeks duration together with weight loss, night sweats, fatigue, and fever.

Back 31

Tuberculosis

Front 32

35 y/o M presents with shortness of breath and cough. He has had unprotected sex with multiple sexual partners and was recently exposed to a patient with active tuberculosis

Back 32

Tuberculosis

Front 33

50 y/o M presents with cough that is exacerbated by lying down at night and improved by propping up on three pillows. He also reports exertional dyspnea

Back 33

CHF

Front 34

60 y/o M presents with sudden onset of substernal heavy chest pain that has lasted 30 minutes and radiates to the left arm. The pain is accompanied by dyspnea, diaphoresis, and nausea. He has a history of hypertension, hyperlipidemia, and smoking

Back 34

MI

Front 35

20 y/o African-American F presents with acute onset of severe chest pain. She has a history of sickle cell disease and multiple previous hospitalizations for pain and anemia management

Back 35

Sickle cell disease--pulmonary infarction

Front 36

45 y/o F presents with a retrosternal burning sensation that occurs after heavy meals and when lying down. Her symptoms are relieved by antacids

Back 36

GERD

Front 37

34 y/o F presents with retrosternal stabbing chest pain that improves when she leans forward and worsens with deep inspiration. She had a URI one week ago

Back 37

Pericarditis

Front 38

55 y/o M presents with retrosternal squeezing pain that lasts for two minutes and occurs with exercise. It is relieved by rest and is not related to food intake

Back 38

Angina

Front 39

34 y/o F presents with stabbing chest pain that worsens with deep inspiration and is relieved by aspirin. She had a URI one week ago. Chest wall tenderness is noted

Back 39

Costochondritis

Front 40

70 y/o F presents with acute onset of shortness of breath at rest and pleuritic chest pain. She also presents with tachycardia, hypotension, tachypnea, and mild fever. She is recovering from hip replacement surgery

Back 40

Pulmonary embolism

Front 41

55 y/o M presents with sudden onset of severe chest pain that radiates to the back. He has a history of uncontrolled hypertension

Back 41

Aortic dissection

Front 42

70 y/o diabetic M presents with episodes of palpitation and diaphoresis. He is on insulin

Back 42

Hypoglycemia

Front 43

42 y/o F presents with a 7kg weight loss over the past two months. She has a fine tremor, and her pulse is 112

Back 43

Hyperthyroidism

Front 44

44 y/o F presents with weight gain of >11 kg over the past two months. She quit smoking three months ago and is on amitriptyline for depression. She also reports cold intolerance and constipation

Back 44

Smoking cessation

Front 45

75 y/o M presents with dysphagia that started with solids and progressed to liquids. He is an alcoholic and a heavy smoker. He has had an unintentional weight loss of 7kg over the past four months

Back 45

Esophageal cancer

Front 46

45 y/o F presents with dysphagia for two weeks together with fatigue and a craving for ice and clay

Back 46

Plummer-Vinson syndrome

Front 47

48 y/o F presents with dysphagia for both solid and liquid foods that has slowly progressed in severity over the past year. It is associated with regurgitation of undigested food, especially at night

Back 47

Achalasia

Front 48

38 y/o M presents with dysphagia and pain on swallowing solids more than liquids. Exam reveals oral thrush

Back 48

Esophagitis (CMV, HSV, pill-induced)

Front 49

20 y/o F presents with nausea, vomiting (especially in the morning), fatigue, and polyuria. Her last menstrual period was six weeks ago, and her breasts are full and tender. She is sexually active with her boyfriend, and they use condoms for contraception

Back 49

Pregnancy

Front 50

45 y/o M presents with sudden onset of colicky right-sided flank pain that radiates to the testicles, accompanied by nausea, vomiting, hematuria, and CVA tenderness

Back 50

Nephrolithiasis

Front 51

60 y/o M presents with dull epigastric pain that radiates to the back, together with weight loss, dark urine, and clay-colored stool. He is a heavy drinker and smoker

Back 51

Pancreatic cancer

Front 52

56 y/o M presents with severe midepigastric abdominal pain that radiates to the back and improves when he leans forward. He also reports anorexia, nausea, and vomiting. He is an alcoholic and has spent the last three days binge drinking

Back 52

Acute pancreatitis

Front 53

41 y/o obese F presents with RUQ abdominal pain that radiates to the right scapula and is associated with nausea, vomiting, and a fever of 101.5. The pain started after she had eaten fatty food. She has had similar but less intense episodes that lasted a few hours. Exam reveals positive Murphy's sign

Back 53

Acute cholecystitis

Front 54

43 y/o obese F presents with RUQ abdominal pain, fever, and jaundice. She was diagnosed with asymptomatic gallstones one year ago

Back 54

Ascending cholangitis

Front 55

25 y/o M presents with RUQ pain, fever, anorexia, nausea, and vomiting. He has dark urine and clay-colored stool

Back 55

Acute hepatitis

Front 56

35 y/o M presents with burning epigastric pain that started 2-3 hours after meals. The pain is relieved by food and antacids

Back 56

Peptic ulcer disease

Front 57

37 y/o M presents with severe epigastric pain, nausea, vomiting, and mild fever. He appears toxic. He has a history of intermittent epigastric pain that is relieved by food and antacids. He also smokes heavily and takes aspirin on a regular basis

Back 57

Peptic ulcer perforation

Front 58

18 y/o M boxer presents with severe abdominal pain that radiates to the scapula. He had infectious mononucleosis three weeks ago

Back 58

Splenic rupture

Front 59

40 y/o M presents with crampy abdominal pain, vomiting, abdominal distension, and inability to pass flatus or stool. He has a history of multiple abdominal surgeries

Back 59

Intestinal obstruction

Front 60

70 y/o F presents with acute onset of severe, crampy abdominal pain. She recently vomited and had a massive dark bowel movement. She has a history of CHF and atrial fibrillation, for which she has received digitalis. Her pain is out of proportion to the exam

Back 60

Mesenteric ischemia/infarction

Front 61

21 y/o F presents with acute onset of severe RLQ pain, nausea, and vomiting. She has no fever, urinary symptoms, or vaginal bleeding and has never taken OCPs. Her last menstrual period was regular, and she has no history of STDs

Back 61

Ovarian torsion

Front 62

68 y/o M presents with LLQ abdominal pain, fever, and chills for the past three days. He also reports recent onset of alternating diarrhea and constipation. He consumes a low-fiber, high-fat diet

Back 62

Diverticulitis

Front 63

20 y/o M presents with severe RLQ abdominal pain, nausea, and vomiting. His discomfort started yesterday as a vague pain around the umbilicus. As the pain worsened, it became sharp and migrated to the RLQ. McBurney's and psoas signs are positive

Back 63

Acute appendicitis

Front 64

30 y/o F presents with periumbilical pain for six months. The pain never awakens her from sleep. It is relieved by defecation and worsens when she is upset. She has alternating constipation and diarrhea but no nausea, vomiting, weight loss, or anorexia

Back 64

Irritable bowel syndrome

Front 65

24 y/o F presents with bilateral lower abdominal pain that started with the first day of her menstrual period. The pain is associated with fever and a thick, greenish-yellow vaginal discharge. She has had unprotected sex with multiple sexual partners

Back 65

PID

Front 66

67 y/o M presents with alternating diarrhea and constipation, decreased stool caliber, and blood in the stool for the past eight months. He also reports unintentional weight loss. He is on a low-fiber diet and has a family history of colon cancer

Back 66

Colorectal cancer

Front 67

28 y/o M presents with constipation (very hard stool) for the past three weeks. Since his mother died two months ago, he and his father have eaten only junk food

Back 67

Low-fiber diet

Front 68

30 y/o F presents with alternating constipation and diarrhea and abdominal pain that is relieved by defecation. She has no nausea, vomiting, weight loss, or blood in her stool

Back 68

Irritable bowel syndrome

Front 69

33 y/o M presents with watery diarrhea, vomiting, and diffuse abdominal pain that began yesterday. He also reports feeling hot. Several of his coworkers are also ill.

Back 69

Infectious diarrhea (gastroenteritis)--bacterial, viral, parasitic, protozoal

Front 70

40 y/o F presents with watery diarrhea and abdominal cramps. Last week she was on antibiotics for a UTI

Back 70

Pseudomembranous (Clostridium difficile) colitis

Front 71

25 y/o M presents with watery diarrhea and abdominal cramps. He was recently in Mexico

Back 71

Traveler's diarrhea

Front 72

30 y/o F presents with watery diarrhea and abdominal cramping and bloating. Her symptoms are aggravated by milk ingestion and are relieved by fasting

Back 72

Lactose intolerance

Front 73

33 y/o M presents with watery diarrhea, diffuse abdominal pain, and weight loss over the past three weeks. He has not responded to antibiotics

Back 73

Crohn's disease

Front 74

45 y/o F presents with coffee-ground emesis for the last three days. Her stool is dark and tarry. She has a history of intermittent epigastric pain that is relieved by food and antacids

Back 74

Bleeding peptic ulcer

Front 75

40 y/o F presents with epigatric pain and coffee-ground emesis. She has a history of rheumatoid arthritis that has been treated with aspirin. She is an alcoholic

Back 75

Gastritis

Front 76

67 y/o M presents with blood in his stool, weight loss, and constipation. He has a family history of colon cancer

Back 76

Colorectal cancer

Front 77

33 y/o F presents with rectal bleeding and diarrhea for the past week. She has had lower abdominal pain and tenesmus for several months

Back 77

Ulcerative colitis

Front 78

58 y/o M presents with bright red blood per rectum and chronic constipation. He consumes a low-fiber diet

Back 78

Diverticulosis

Front 79

65 y/o M presents with painless hematuria. He is a heavy smoker and works as a painter

Back 79

Bladder cancer

Front 80

35 y/o M presents with painless hematuria. He has a family history of kidney problems

Back 80

Polycystic kidney disease

Front 81

55 y/o M presents with flank pain and blood in his urine without dysuria. He has experienced weight loss and fever over the past two months.

Back 81

Renal cell carcinoma

Front 82

60 y/o M presents with nocturia, urgency, weak stream, and terminal dribbling. He denies any weight loss, fatigue, or bone pain. He has had two episodes of urinary retention that required catheterization

Back 82

Benign prostatic hypertrophy (BPH)

Front 83

71 y/o M presents with nocturia, urgency, weak stream, terminal dribbling, hematuria, and lower back pain over the past four months. He has also experienced weight loss and fatigue.

Back 83

Prostate cancer

Front 84

18 y/o M presents with burning sensation during urination and urethral discharge. He recently had unprotected sex with a new partner

Back 84

Urethritis

Front 85

45 y/o diabetic F presents with dysuria, urinary frequency, fever, chills, and nausea over the past three days. There is left CVA tenderness on exam

Back 85

Acute pyelonephritis

Front 86

47 y/o M presents with impotence that started three months ago. He has hypertension and was started on atenolol four months ago. He also has diabetes and is on insulin

Back 86

Drug-related ED

Front 87

40 y/o F presents with amenorrhea, morning nausea and vomitting, fatigue, and polyuria. Her last menstrual period was six weeks ago, and her breasts are full and tender. She uses the rhythm method for contraception

Back 87

Pregnancy

Front 88

23 y/o obese F presents with amenorrhea for six months, facial hair, and infertility for the past three years

Back 88

Polycystic ovarian syndrome

Front 89

35 y/o F presents with amenorrhea, galactorrhea, visual field defects, and headaches for the past six months

Back 89

Amenorrhea secondary to prolactinoma

Front 90

48 y/o F presents with amenorrhea for the past six months accompanied by hot flushes, night sweats, emotional lability, and dyspareunia

Back 90

Menopause

Front 91

35 y/o F presents with amenorrhea, cold intolerance, coarse hair, weight loss, and fatigue. She has a history of abruptio placentae followed by hypovolemic shock and failure of lactation two years ago

Back 91

Sheehan's syndrome

Front 92

18 y/o F presents with amenorrhea for the past four months. She has lost 95 pounds and has a history of vigorous exercise and cold intolerance

Back 92

Anorexia nervosa

Front 93

29 y/o F presents with amenorrhea for the past six months. She has a history of occasional palpitations and dizziness. She lost her fiance in a car accident

Back 93

Anxiety-induced amenorrhea

Front 94

17 y/o F presents with prolonged, excessive menstrual bleeding occuring irregularly over the past six months

Back 94

Dysfunctional uterine bleeding

Front 95

61 y/o obese F presents with profuse vaginal bleeding over the past month. Her last menstrual period was 10 years ago. She has a history of hypertension and diabetes mellitus. She is nulliparous

Back 95

Endometrial cancer

Front 96

45 y/o G5P5 F presents with postcoital bleeding. She is a cigarette smoker and takes OCPs

Back 96

Cervical cancer

Front 97

28 y/o F who is eight weeks pregnant presents with lower abdominal pain and vaginal bleeding

Back 97

Spontaneous abortion

Front 98

32 y/o F presents with sudden onset of left lower abdominal pain that radiates to the scapula and back and is associated with vaginal bleeding. Her last menstrual period was five weeks ago. She has a history of PID and unprotected intercourse

Back 98

Ectopic pregnancy

Front 99

28 y/o F presents with a thin, grayish-white, foul-smelling vaginal discharge

Back 99

Bacterial vaginosis

Front 100

30 y/o F presents with a thick, white, cottage cheese-like, odorless vaginal discharge and vaginal itching

Back 100

Vaginitis--Candidal

Front 101

35 y/o F presents with malodorous, profuse, frothy, greenish vaginal discharge with intense vaginal itching and discomfort

Back 101

Vaginitis--trichomonal

Front 102

54 y/o F c/o painful intercourse. Her last menstrual period was nine months ago. She has hot flushes

Back 102

Atrophic vaginitis

Front 103

37 y/o F presents with dyspareunia, inability to conceive, and dysmenorrhea

Back 103

Endometriosis

Front 104

28 y/o F c/o multiple facial and bodily injuries. She claims that she fell on the stairs. She was hospitalized for some physical injuries seven months ago. She presents with her husband

Back 104

Domestic violence

Front 105

30 y/o F presents with multiple facial physical injuries. She was attacked and raped by two men

Back 105

Rape

Front 106

30 y/o F presents with wrist pain and a black eye after tripping, falling, and hitting her head on the edge of a table. She looks anxious and gives an inconsistent story

Back 106

Domestic violence

Front 107

30 y/o F secretary presents with wrist pain and a sensation of numbness and burning in her palm and the first, second, and third fingers of her right hand. The pain worsens at night and is relieved by loose shaking of the hand. There is sensory loss in the same fingers. Exam reveals positive Tinel's sign

Back 107

Carpal tunnel syndrome

Front 108

28 y/o F presents with pain in the interphalangeal joints of her hands together with hair loss and a butterfly rash on the face

Back 108

SLE

Front 109

28 y/o F presents with pain in the metacarpophalangeal joints of both hands. Her left knee is also painful and red. She has morning joint stiffness that lasts for an hour.

Back 109

Rheumatoid arthritis

Front 110

18 y/o M presents with pain in the interphalangeal joints of both hands. He also has scaly, salmon-pink lesions on the extensor surface of his elbows and knees

Back 110

Psoriatic arthritis

Front 111

65 y/o F presents with inability to use her left leg and bear weight on it after tripping on a carpet. Onset of menopause was 20 years ago, and she did not receive HRT or calcium supplements. Her left leg is externally rotated, shortened, and adducted, and there is tenderness in her left groin

Back 111

Hip fracture

Front 112

40 y/o M presents with pain in the right groin after a motor vehicle accident. His right leg is flexed at the hip, adducted, and internally rotated

Back 112

Hip dislocation--traumatic

Front 113

56 y/o obese F presents with right knee stiffness and pain that increases with movement. Her symptoms have gradually worsened over the past 10 years. She noticed swelling and deformity of the joint and is having difficulty walking

Back 113

Osteoarthritis

Front 114

45 y/o M presents with right knee pain with swelling and redness

Back 114

Septic arthritis

Front 115

65 y/o M presents with right foot pain. He has been training for a marathon

Back 115

Stress fracture

Front 116

65 y/o M presents with pain in the heel of the right foot that is most notable with his first few steps and then improves as he continues walking. He has no known trauma

Back 116

Plantar fasciitis

Front 117

55 y/o M presents with pain in the elbow when he plays tennis. His grip is impaired as a result of the pain. There is tenderness over the lateral epicondyle as well as pain on resisted wrist dorsiflexion with the elbow in extension

Back 117

Tennis elbow (lateral epicondylitis)

Front 118

27 y/o F presents with painful wrists and elbows, a swollen and hot knee joint that is painful to flexion, a rash on her limbs, and vaginal discharge. She is sexually active with multiple partners and occasionally uses condoms

Back 118

Disseminated gonorrhea

Front 119

60 y/o F presents with pain in both legs that is induced by walking and relieved by rest. She had cardiac bypass surgery six months ago and continues to smoke heavily

Back 119

Peripheral vascular disease (intermittent claudication)

Front 120

45 y/o F presents with right calf pain. Her calf is tender, warm, red, and swollen compared to the left side. She was started on OCPs two months ago for dysfunctional uterine bleeding

Back 120

DVT

Front 121

60 y/o F c/o left arm pain that started while she was swimming and was relieved by rest

Back 121

Angina/MI

Front 122

50 y/o M presents with right shoulder pain after falling onto his outstretched hand while skiing. He noticed deformity of his shoulder and had to hold his right arm

Back 122

Shoulder dislocation

Front 123

55 y/o M presents with crampy bilateral thigh and calf pain, fatigue, and dark urine. He is on simvastatin and clofibrate for hyperlipidemia

Back 123

Rhabdomyolysis due to simvastatin or clofibrate

Front 124

45 y/o F presents with low back pain that radiates to the lateral aspect of her left foot. Straight leg raising is positive. The patient is unable to tiptoe

Back 124

Disk herniation

Front 125

45 y/o F presents with low back pain that started after she cleaned her house. The pain does not radiate, and there is no sensory deficit or weakness in her legs. Paraspinal muscle tenderness and spasm are also noted

Back 125

Lumbar muscle strain

Front 126

45 y/o M presents with pain in the lower back and legs during prolonged standing and walking. The pain is relieved by sitting and leaning forward (e.g. pushing a grocery cart)

Back 126

Lumbar spinal stenosis

Front 127

17 y/o M presents with low back pain that radiates to the left leg and began after he fell on his knee during gym class. He also describes areas of loss of sensation in his left foot. The pain and sensory loss do not match any known distribution. He insists on requesting a week off from school because of his injury

Back 127

Malingering

Front 128

20 day old M presents with fever, decreased breast feeding, and lethargy. He was born at 36 weeks as a result of premature rupture of membranes

Back 128

Neonatal sepsis

Front 129

3 y/o M presents with a two-day history of fever and pulling on his right ear. He is otherwise healthy, and his immunizations are up to date. His older sister recently had a cold. The child attends a day care center

Back 129

Acute otitis media

Front 130

12 month old M presents with fever for the last two days accompanied by a maculopapular rash on his face and body. His immunizations are not up to date

Back 130

Measles (or other viral exanthem)

Front 131

4 y/o M presents with diarrhea, vomiting, lethargy, weakness, and fever. The child attends a day care center where several children have had similar symptoms

Back 131

Gastroenteritis (viral, bacterial, parasitic)

Front 132

9 y/o M presents with a two-year history of angry outbursts both in school and at home. His mother complains that he runs around "as if driven by a motor." His teacher reports that he cannot sit still in class, regularly interrupts his classmates, and has trouble making friends

Back 132

ADHD

Front 133

12 y/o F presents with two month history of fighting in school, truancy, and breaking curfew. Her parents recently divorced, and she just started school in a new district. Before her parents divorced, she was an average student with no behavioral problems

Back 133

Adjustment disorder

Front 134

15 y/o M presents with one year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report that he spends most of his time alone in his room, adding that when he does go out, it is with a new set of friends

Back 134

Substance abuse

Front 135

5 y/o M presents with a six-month history of temper tantrums that last 5-10 minutes and immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change in appetite, and does not display these behaviors when he is at day care

Back 135

Age-Appropriate behavior

Front 136

21 y/o F presents with several episodes of throbbing left temporal pain that lasts for 2-3 hours. Prior to its onset, she sees flashes of light in her right visual field and feels weakness and numbness on the right side of her body for a few minutes. Headaches are often associated with nausea and vomiting. She has a family history of migraine

Back 136

Migraine (complicated)

Front 137

26 y/o M presents with terrible right temporal headaches associated with ipsilateral rhinorrhea and eye tearing and redness. Episodes have occured at the same time every night for the past week and last for 45 minutes

Back 137

Cluster headache

Front 138

65 y/o F presents with severe, intermittent right temporal headache, fever, blurred vision in her right eye, and pain in her jaw when chewing

Back 138

Temporal ateritis (giant cell arteritis)

Front 139

30 y/o F presents with frontal headache, fever, and nasal discharge. There is pain on palpation of the frontal and maxillary sinuses.

Back 139

Sinusitis

Front 140

50 y/o F presents with recurrent episodes of bilateral squeezing headaches that occur 3-4 times a week. She is experiencing significant stress in her life

Back 140

Tension headache

Front 141

35 y/o M presents with sudden severe headache, vomiting, confusion, left hemiplegia, and nuchal rigidity

Back 141

Subarachnoid hemorrhage

Front 142

25 y/o M presents with high fever, severe headache, confusion, photophobia, and nuchal rigidity. Kernig's and Brudzinski's signs are positive

Back 142

Meningitis

Front 143

18 y/o obese F presents with headache, vomiting, and blurred vision for the past 2-3 weeks. She is taking OCPs

Back 143

Pseudotumor cerebri

Front 144

47 y/o M c/o daily pain in the right cheek over the past month. The pain is electric in character and occurs while he is shaving. Each episode lasts 2-4 minutes

Back 144

Trigeminal neuralgia

Front 145

81 y/o M presents with progressive confusion over the past several years together with forgetfulness and clumsiness. He has a history of diabetes mellitus, hypertension, and two strokes with residual left hemiparesis. Mental status has clearly worsened after each stroke

Back 145

Vascular (multi-infarct) dementia

Front 146

84 y/o F brought by her son c/o forgetfulness (e.g forgets phone numbers, loses her way back home) along with difficulty performing some of her daily activities (e.g. bathing, dressing, managing her money, using the phone). The problem has gradually progressed over the past few years

Back 146

Alzheimer's disease

Front 147

72 y/o M presents with memory loss, gait disturbance, and urinary incontinence for the past six months

Back 147

Normal pressure hydrocephalus

Front 148

55 y/o M presents with a rapidly progressive change in mental status, inability to concentrate, and memory impairment for the past two months. His symptoms are associated with myoclonus and ataxia

Back 148

Creutzfeldt-Jakob disease

Front 149

70 y/o insulin dependent diabetic M presents with episodes of confusion, dizziness, palpitation, diaphoresis, and weakness

Back 149

Hypoglycemia

Front 150

55 y/o F presents with gradual altered mental status and headache. Two weeks ago she slipped, hit her head on the ground, and lost consciounsess for two minutes

Back 150

Subdural hematoma

Front 151

68 y/o M presents with two month history of crying spells, excessive sleep, poor hygiene, and a 7kg weight loss, all following his wife's death. He cannot enjoy time with his grandchilren and reluctantly admits to thinking he has seen his dead wife in line at the supermarket or standing in the kitchen making dinner

Back 151

Normal bereavement

Front 152

42 y/o F presents with a four-week history of excessive fatigue, insomnia, and anhedonia. She states that she thinks constantly about death. She has suffered five similar episodes in the past, the first in her 20s, and has made two previous suicide attempts. She further admits to increased alcohol use in the past month

Back 152

Major depressive disorder

Front 153

26 y/o F presents with a 3kg weight loss over the past two months, accompanied by early-morning awakening, excessive guilt, and psychomotor retardation. She does not identify a trigger for the depressive episode but reports several weeks of increasing energy, sexual promiscuity, irresponsible spending, and racing thoughts approximately six months before her presentation

Back 153

Bipolar I

Front 154

19 y/o M c/o receiving messages from his television set. He reports that he did not have many friends in high school. In college, he started to suspect his roommate of bugging the phone. In the same time frame, he stopped going to classes because he felt that his professors were saying horrible things about him that no one else noticed. He rarely showered or left his room and has recently been hearing a voice from his television telling him to "guard against the evil empire".

Back 154

Schizophrenia

Front 155

28 y/o F c/o seeing bugs crawling on her bed over the past two days and reports hearing loud voices when she is alone in her room. She has never experienced symptoms such as these in the past. She recently ingested an unknown substance

Back 155

Substance-induced psychosis

Front 156

48 y/o F presents with a one-week history of auditory hallucinations, stating, "I am worthless" and "I should kill myself". She also reports a two-week history of weight loss, early morning awakening, decreased motivation, and overwhelming feelings of guilt

Back 156

Schizoaffective disorder

Front 157

35 y/o F presents with intermittent episodes of vertigo, tinnitus, nausea, and hearing loss over the past week

Back 157

Meniere's disease

Front 158

55 y/o F c/o dizziness for the past day. She feels faint and has severe diarrhea that stated two days ago. She takes furosemide for her hypertension

Back 158

Orthostatis hypotension due to dehydration (diarrhea, diuretic use)

Front 159

65 y/o M presents with postural dizziness and unsteadiness. He has hypertension and was started on HCTZ two days ago

Back 159

Drug-induced orthostatic hypotension

Front 160

44 y/o F c/o dizziness on moving her head to the left. She feels that the room is spinning around her head. Tilt test results in nystagmus and nausea

Back 160

Benign positional vertigo

Front 161

55 y/o F c/o dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI two days ago and has experienced no hearing loss

Back 161

Vestibular neuronitis

Front 162

55 y/o F c/o dizziness that started this morning and of "not hearing well." She feels nauseated and has vomited once in the past day. She had a URI two days ago

Back 162

Labyrinthitis